Why Choose Cedars-Sinai Marina del Rey Hospital for Coronary Artery Disease Treatment?
A wide range of surgical treatment approaches, as well as non-invasive medical procedures for coronary artery disease are available at Cedars-Sinai Marina del Rey Hospital. The well-trained medical professionals will help you choose the most suitable treatment method for this condition, depending on its complexity, in order to significantly improve your quality of life.
Coronary artery disease (CAD) is the most common heart disease that occurs due to the deposition of a waxy substance called plaque on the inner surface of the coronary arteries (atherosclerosis). The coronary arteries provide oxygenated blood to the heart muscles.
The plaque buildup continues for several years, and eventually, plaque may harden or rupture. The hardened plaque causes narrowing of the coronary arteries that result in the lesser supply of oxygen-rich blood to the heart. As a result, the heart muscle becomes deprived of oxygen and leads to the development of angina or heart attack.
Angina is chest discomfort, which is felt as a pressure or squeezing sensation in the chest. In cases where the plaque ruptures, a blood clot may form on its surface. A large blood clot may cause complete blockage of blood flow through the coronary artery and permanent damage to the heart if the blood supply is not restored quickly. Gradually, CAD may weaken the heart muscles that give rise to conditions such as heart failure and arrhythmia.
Coronary Artery Disease Surgical Procedures Performed at Cedars-Sinai Marina del Rey Hospital
Surgical treatment is considered as the last resort when medications and other conservative treatment methods become inefficient in the treatment of CAD. Our cardiothoracic surgeons will perform a surgical procedure called Coronary Artery Bypass Grafting (CABG) to treat the blocked coronary arteries. CABG is the procedure in which arteries or veins are harvested from other parts of your body and placed to bypass the narrow coronary arteries. This allows proper blood flow to the heart, relieves chest pain, and prevents heart attack. There are various types of CABG techniques, which include:
Traditional Coronary Artery Bypass Grafting
During this procedure, you will be under general anesthesia and a breathing tube will be inserted through the throat into your lungs. The tube will be connected to a ventilator. Your surgeon will make an incision about 6-8 inches in length, down the central portion of your chest. The chest bone is divided so that the heart can be accessed.
You will be given medicines that stop your heartbeat while a heart-lung bypass machine keeps oxygenated blood flowing throughout your body during the procedure. Your surgeon will harvest an artery or a vein from your chest or leg, to be used as the bypass graft. The left internal mammary artery, located within the chest in close proximity to the heart, is commonly used as an artery graft. The saphenous vein located on the inner side of the leg is commonly used as a vein graft.
Once your surgeon completes the grafting procedure, restoration of blood flow to your heart is done, and the heart begins beating. In some cases, a mild electric shock is given to restart the heart. This procedure may last for about 3-6 hours.
Nontraditional Coronary Artery Bypass Grafting
Nontraditional CABG can be performed using two techniques that include:
- Off-Pump CABG: This technique is also called beating heart bypass grafting as the heart is not stopped and a heart-lung machine is not used during the procedure. The surgeon makes use of a mechanical device to stabilize the heart.
- Minimally Invasive Direct CABG (MIDCAB procedure): This technique is different from the traditional bypass surgery as the chest bone is not cut open to access the heart, and a heart-lung bypass machine is not required. This surgery is used to bypass arteries present at the front portion of the heart. Smaller incisions (3 inches in length) are made in between the ribs on the left side of your chest so that the artery to be bypassed is exposed. The two approaches used in MIDCAB grafting include:
- Port-access coronary artery bypass procedure: This procedure is performed through small incisions or ports made in the chest. A heart-lung bypass machine may be used during this procedure.
- Robot-assisted technique: This procedure involves the use of smaller, keyhole-sized incisions. A tiny video camera is passed through one of the incisions to help visualize the heart while your surgeon uses remote-controlled surgical tools to perform the surgery. A heart-lung bypass machine may be used sometimes.
Drugs and Other Treatment Needed for Coronary Artery Disease
Your cardiologist may prescribe certain medications in addition to lifestyle changes. Other noninvasive treatment methods include percutaneous coronary intervention which is commonly termed angioplasty, may be advised. This is a nonsurgical procedure that helps open up the blocked or narrowed coronary arteries.
Lifestyle Changes »
Medical Procedures »
The three types of coronary artery disease together are known as Acute Coronary Syndrome and are related to sudden detachment of plaque buildup from the inner lining of the coronary artery. The type of acute coronary syndrome is determined by the location of the blockage in the artery, the time period for which the blood flow is blocked, and the amount of resultant heart damage.
This is an alteration from stable angina. It is more severe, and occurs more often, easily during rest, and lasts for a longer period. It can be relieved by taking oral medications, but as it is unstable may further progress to a heart attack. This condition is treated as a medical emergency.
Infarction Or Heart
Attack (NSTEMI) »
ST Segment Elevation
Myocardial Infarction Or
Heart Attack (STEMI) »
Symptoms of Coronary Artery Disease
Sometimes, patients with CAD may not experience any symptoms. This condition is called ‘silent CHD’. A common symptom of CAD is angina or chest discomfort that occurs when your heart muscle is deprived of oxygen-rich blood. Shortness of breath may occur if CAD results in heart failure.
Signs and Symptoms of Heart Problems Related to Coronary Artery Disease
A patient with CAD may have signs of heart problems such as heart attack, heart failure, or arrhythmia.
- Heart Attack: Most of the time, heart attacks involve discomfort felt as a squeezing pain in the center or the left side of the chest. This is felt for more than a few minutes, then may get relieved, and even reappear again. Chest pain that does not relieve as usual or occurs more often during rest is a sign of heart attack. Other signs and symptoms of heart attack include:
- Shortness of breath that may occur with or just before chest pain
- Discomfort in one or both the arms, the neck, the jaws, the back, or upper part of the stomach
- Nausea, vomiting, fainting, and cold sweats
- Lethargy, tiredness, and sleep disturbances
- Heart Failure: The common symptom of heart failure is shortness of breath or troubled breathing. Other symptoms include swollen ankles, feet, legs, and stomach due to fluid retention in the body and fatigue.
- Arrhythmia: The symptoms of arrhythmia include a feeling of fluttering in the chest (palpitations), fast heartbeat or skipped beats, and sudden cardiac arrest.
Diagnosis of Coronary Artery Disease
The diagnosis of CAD will be made on the basis of the information gained through your medical and family history, physical examination, the presence of risk factors, and the results of diagnostic tests. One or more of the following tests may be advised by your cardiologist.
An EKG is a simple, painless test that can reveal signs of heart damage, previous or current heart attack. It can detect and record the electrical activity of the heart rate of heartbeat and its rhythm.
During the stress test, you keep exercising while the heart tests are done. While being active, the heart works hard and tends to beat faster as it requires more oxygen. In patients with CAD, the narrow arteries are unable to supply sufficient oxygenated blood to meet the heart’s requirements. Thus, a stress test done in a patient with CAD shows the following signs:
During the test, pictures of the heart are taken while exercising and rest. The imaging stress tests reveal how well the heart pumps the blood, and the way it is circulated in the heart.
Echocardiography makes use of sound waves to create a picture of the heart that shows the size, shape and function of chambers and valves of the heart. It can also reveal areas of the heart that receive poor blood supply, heart muscles that do not contract well, and past injury to the heart muscle because of poor blood supply.
A chest x-ray is done to detect signs of heart failure and lung disorders.
Blood tests are done to check levels of cholesterol, sugar, and proteins in the blood. Abnormal levels of these may indicate a risk for CAD.
Coronary Angiography and Cardiac Catheterization
Coronary angiography may be suggested if the results of other tests indicate the likelihood of CAD. In this test, a dye and special X-rays are used to study the blood flow through the coronary arteries. A procedure called cardiac catheterization is performed to inject the dye into the coronary arteries. This involves the passage of a thin, flexible tube (catheter) into a blood vessel in the arm, groin, or neck. The tube is then threaded into the coronary arteries, and the special dye is injected. While the dye flows through the coronary arteries, a special X-ray is taken.
Risk Factors for Coronary Artery Disease
Coronary artery disease is the leading cause of death in both men and women in the United States. CAD risk factors are conditions or habits that heighten your risk for coronary heart disease (CHD) and heart attack. There are certain conditions, traits, or habits that increase your risk for CAD. You are more likely to develop CAD if you have more of these risk factors. Most of the risk factors may be brought under control so that CAD is either prevented or delayed.
Major Risk Factors
- Unhealthy levels of blood cholesterol: This may include low levels of HDL cholesterol or good cholesterol and high levels of LDL cholesterol or bad cholesterol.
- Unhealthy diet: Intake of foods having high amounts of saturated and trans fats, cholesterol, sodium, and sugar can raise your risk for CAD.
- High blood pressure levels: Blood pressure at or above 140/90 mmHg.
- Smoking: This causes damage to blood vessels leading to abnormal cholesterol levels and increased blood pressure. It decreases the amount of oxygen reaching the body tissues.
- Diabetes and Insulin resistance: With diabetes, the blood sugar level increases as the body is incapable of producing sufficient amount of insulin or insulin resistance may develop wherein the body is not able to make use of the insulin in a proper manner.
- Being overweight or obesity: Weighing more than what is considered healthy for a particular height is considered as being overweight.
- Metabolic syndrome: It is a group of risk factors that increase your risk for CAD
- Lack of physical exercise: It may worsen other risk factors for CAD such as abnormal blood cholesterol levels, high blood pressure, diabetes, and obesity.
- Older age: As we age, genetic or our lifestyle influences lead to plaque buildup in the arteries. In men, the risk for CAD starts increasing at the age of 45, while in women the risk increases by the age of 55.
- Family history: Occurrence of early CAD in parents or siblings may increase your risk for CAD.
Emerging Risk Factors
The other potential risk factors for CAD are being studied by researchers. These include high blood levels of a protein called C-reactive protein (CRP). High CRP levels indicate the presence of inflammation in the body. In this case, damage to the inner wall of arteries induces inflammation and supports the growth of plaque. High triglyceride levels in the blood may increase the risk for CAD, particularly in women.
Other Risk Factors Related to Coronary Heart Disease
Other conditions that contribute to the development of CAD include:
- Stress: Anger and related stress is the most common triggering factor of a heart attack.
- Alcohol: Heavy intake of alcohol damages the heart muscles and worsens other risk factors for CAD.
- Sleep apnea: This disorder involves one or more pauses in breathing or shallow breathing while asleep. It can increase your risk for high blood pressure, diabetes, heart attack, and stroke.
- Preeclampsia: This may occur during pregnancy, and it involves a rise in blood pressure and excessive protein excretion through urine.
Most people possess at least one among the CAD risk factors. Most risk factors for CAD begin early in life and are more common in the recent years as children are often overweight due to inadequate physical exercise.
Causes of Coronary Artery Disease
Coronary artery disease is caused by certain factors that damage the inner lining of the coronary arteries. These etiological factors include:
The plaque deposits at places where the arteries get damaged. The plaque buildup in the coronary arteries starts as early as childhood. Gradually, over time, the plaque hardens or breaks down. The hardened plaque can narrow down the coronary arteries and decrease the blood flow to the heart. This leads to angina or chest discomfort. In case, the plaque breaks down, the blood cell fragments called platelets adhere to the injury site. These aggregate and form blood clots that further narrow down the coronary arteries and worsen angina. If the clot is large, it can block the coronary artery completely and cause a heart attack.
Our patients will be advised to seek alternative medicine treatments before we resort to surgical methods of treatment. These include:
Chiropractic care encompasses a natural, non-invasive way of treatment that helps in the management of heart diseases. It is also helpful in preventing the occurrence of heart diseases. Patients with cardiovascular disease may seek chiropractic care to lower their risk factors. Chiropractic adjustments in combination with lifestyle modifications such as healthy diet and increased physical activity may help in getting the levels of cholesterol and triglycerides back to normal.
In order to maintain a good cardiovascular health, it is recommended to perform at least 30 minutes of moderate intensity aerobic activity for 5 days in a week or at least 25 minutes of vigorous aerobic activity for 3 days in a week. Performing moderate to high-intensity muscle strengthening exercises for at least 2 days in a week helps in attaining additional health benefits.
Yoga involves stretching your body in different poses while concentrating on your breathing as well as meditation. Along with a heart-healthy lifestyle, incorporation of Yoga-based exercises prevents or even reverses heart diseases to a certain extent. Yoga helps you relax your body and manage stress and anxiety that are common triggering factors of CAD. It helps you know yourself better, leading to a healthy lifestyle, thus eliminating the modifiable risk factors for CAD. One can expect great benefits with Yoga, although it may not be able to completely cure the disease.
Coronary artery disease is preventable as there are certain risk factors that can be controlled with the adoption of heart-healthy lifestyle changes, and medicines. The modifiable risk factors include high blood pressure, high blood cholesterol, and obesity. Certain risk factors such as age, gender, and family history cannot be modified. The risk for CAD increases with increase in the number of risk factors present. In order to prevent CAD and heart attack, risk factor should be controlled through heart-healthy lifestyle modifications such as:
Inform your cardiologist if you believe you have a family history of CAD. Medications may be prescribed to control CAD risk factors if lifestyle changes are not sufficient enough to manage your CAD risk factors.
For any questions, information or guidance related to coronary artery disease, consult our specialty-trained, skilled cardiologists at Cedars-Sinai Marina del Rey Hospital.